Questionnaire based gastroesophageal reflux …

1 Indian J Gastroenterol (May June 2011) 30(3):108 117. DOI REVIEW ARTICLE. Questionnaire based gastroesophageal reflux disease ( gerd ) assessment scales V. Pratap Mouli & Vineet Ahuja Received: 7 December 2010 / Accepted: 15 June 2011 / Published online: 23 July 2011. # Indian Society of Gastroenterology 2011. Abstract Questionnaire based assessment scales for gerd as a disease entity has varied presentations. The gastroesophageal reflux disease ( gerd ) have been symptoms may not correlate with the endoscopic picture. utilized for assessment of the patient's symptomatology, The patients may present as any of the following: assessment of symptom severity and frequency, assess- 1. typical heartburn and reflux symptoms with endoscopic ment of health-related quality of life and for assessment evidence of mucosal injury of response to treatment.

2 A multitude of unidimensional 2. symptoms of heartburn and reflux but a normal upper and multidimensional questionnaires exist for making gastrointestinal endoscopy (UGIE). symptom assessment and monitoring quality of life in 3. no esophageal reflux symptoms but evidence of gerd . Many of the scales meet some of the parameters mucosal injury on UGIE or of an ideal evaluative gerd specific assessment instru- 4. atypical symptoms such as dyspepsia, cough, asthma, etc. ment. Yet, there are certain shortcomings and challenges which are faced in development of gerd questionnaires. So aptly the 2006 consensus meeting held at Montreal This review discusses the features of an ideal symptom defined gerd as a condition that develops when the assessment instrument, examines the strengths and reflux of stomach contents causes troublesome symptoms weaknesses of currently available questionnaires.

3 And/or complications [3]. Because of these diverse clinical manifestations, diag- nosis of gerd is not easy or straightforward. Traditional Keywords Diagnosis . gastroesophageal reflux disease . diagnostic modalities such as barium swallow and endos- Health-related quality of life . Treatment assessment copy have a sensitivity of 10% to 50% [4] and 30% to 50%. [5, 6] respectively. 24-h esophageal pH monitoring is also normal in 6% 15% of patients with abnormal symptom The prevalence of gastroesophageal reflux disease ( gerd ) index and not commonly available [7]. So an objective gold ranges from 10% to 30% in the population of Western standard diagnostic test is lacking. In the Indian setting, a countries [1].

4 There is paucity of data regarding the study evaluating the diagnostic algorithm of gerd found magnitude of the problem in India. A recent study has that a combination of omeprazole challenge test, endoscopy shown the prevalence of gerd to be among the and histology will identify all cases of gerd [8]. This employees of a large tertiary hospital in North India [2]. study concluded that 24-h esophageal pH testing, despite being the gold standard, has no utility in routine clinical settings and hence its availability should be limited to V. P. Mouli : V. Ahuja (*) tertiary care settings. The patients were recruited on the Department of Gastroenterology and Human Nutrition, basis of symptom score evaluation (heartburn and/or All India Institute of Medical Sciences, New Delhi 110 029, India regurgitation) highlighting the importance of symptom- e-mail: based questionnaires in the diagnosis of this disease .

5 Indian J Gastroenterol (May June 2011) 30(3):108 117 109. Structured questionnaires for diagnosis of gerd have been Table 1 Scales for symptom assessment in gastroesophageal reflux disease ( gerd ). formulated based on the patients' history. As gerd is a chronic disease , assessment of quality of life is another gerd specific important aspect of the disease evaluation. Questionnaire - gerd specific esophageal symptom Questionnaire [9]. based evaluation has played an important role in clinical gerd specific Questionnaire by Mold et al. [10]. trials of gerd . This has been so because symptom gerd specific Questionnaire by R ih et al. [11]. improvement and improvement of health-related quality of gerd Questionnaire [12].

6 Life (HRQOL) are the main goals of treatment of gerd . Infant gastroesophageal reflux Questionnaire (I-GERQ) [13]. The aim of this review is to discuss the features of an gastroesophageal reflux Questionnaire (GERQ) [14]. ideal symptom assessment instrument, and to examine the gerd Activity Index (GRACI) [15]. strengths and weaknesses of currently available question- gerd specific Questionnaire by Carlsson et al. [16]. naires. The utility of questionnaires in gerd has been gerd specific Questionnaire by Manterola et al. [17]. found in the following settings: gerd score [18]. 1. assessment of the patient's symptoms gerd Symptom Assessment Scale (GSAS) [19]. 2. assessment of symptom severity and frequency gerd screener [20].

7 3. assessment of HRQOL Questionnaire used by Vigneri et al. [21]. 4. assessment of response to treatment reflux disease diagnostic Questionnaire (RDQ) [22]. Chinese gerd Questionnaire (Chinese GERDQ) [23]. For achieving these objectives the questionnaires Scores for assessment of other diseases along with gerd . should be: Standardized esophageal symptom Questionnaire [24]. 1. sensitive to diagnose the disease Questionnaire by Andersen et al. [25]. 2. easily scored Gastrointestinal Symptoms Rating Scale (GSRS) [26]. 3. easily understandable Questionnaire by Ruth et al. [27]. 4. easily translatable to local languages Ulcer esophagitis subjective symptoms scale (UESS) [28]. 5. able to evaluate the disease as completely as possible, Digestive health status instrument (DHSI) [29].

8 Covering all types of typical and atypical symptoms Modified bowel disease Questionnaire (BDQ) [30]. 6. able to assess changes with therapy over shorter as well as longer duration 7. self reported/self administered 8. economical 9. psychometrically validated in clinical trials Table 2 Scales for quality of life assessment in gastroesophageal reflux disease ( gerd ). The questionnaires may be classified into - a) symptom assessing questionnaires (Table 1), b) health-related quality gerd specific of life assessing questionnaires (Table 2), and c) hybrid gastroesophageal reflux disease health-related quality of life ( gerd -HRQL) [31]. questionnaires which assess symptom response as well as quality of life (Table 3).

9 The symptom assessing question- Heartburn - specific quality of life instrument (HBQOL) [32]. naires are either specific to gerd or wide covering other gerd specific QoL Questionnaire by Jasani et al. [33]. allied GI diseases. QOL Questionnaire in gastroesophageal reflux ( reflux -Qual) [34]. reflux -qual short-form (RQS) [35]. Work Productivity and Activity Impairment Questionnaire for gerd . (WPAI- gerd ) [36]. Symptom assessment scales in gerd . QoL Questionnaire for patients undergoing antireflux surgery (QOLARS) [37]. Symptom scales used for diagnosis of gerd gerd -QOL [38]. GI specific Greatorex and Thorpe [9] developed the esophageal Gastrointestinal quality of life index (GIQLI) [39]. symptom Questionnaire to assist the diagnosis of gerd .

10 Quality of life in reflux and dyspepsia (QOLRAD) [40]. It contained six items namely heartburn, regurgitation, Patient assessment of upper gastrointestinal disorders (PAGI-QOL) [41]. dysphagia, bleeding, dyspepsia and vomiting, which were Generic scored on a 4-point adjectival scale; the Questionnaire was Psychological general well-being index (PGWB) [42]. completed by the patient in the presence of the examining EuroQoL-5 dimensions (EQ-5D) [43]. doctor. They found that the Questionnaire was valid, but 36-Item short-form general health survey (SF-36) [44]. reliability and responsiveness were not assessed. 110 Indian J Gastroenterol (May June 2011) 30(3):108 117. Table 3 Hybrid scales assessing both symptoms and quality of life in pulmonary symptoms [10].